In its upcoming August issue the magazine, for the first time, rated 1,159 U.S. hospitals in areas that directly affect patients, including hospital-acquired infections and communications about medications.

The highest score, based on a scale of 100, was 72 and more than half received scores below 50.

The Cleveland Clinic Foundation had a rating of 39, University Hospitals Case Medical Center 41 and MetroHealth Medical Center 43.

"The Cleveland Clinic and University Hospitals are leaders in the medical industry, but they need to focus on making safety a No. 1 priority," said Dr. John Santa, director of Consumer Reports Health Ratings Center.

Some smaller hospitals scored higher including St. John Medical Center in Westlake at 62 and Parma Community General Hospital at 59.

Santa acknowledged that large medical centers -- like UH and the Clinic -- get more acute cases compared with smaller hospitals that may have scored higher. But that is even more reason to take steps to make improvements, he said.

The report points out that in the next 10 years, 2.25 million Americans likely will die from medical harm -- one of the three leading causes of death in this country.

Consumer Reports analyzed government and private data in six areas: readmission rates; communications about medications and discharge instructions; infections; overuse of CT scans; complications; and mortality.

Only 18 percent of the hospitals nationwide were on the list because not all states have reporting requirements and not all hospitals participate in data collecting government payment systems like Medicare. Consumer Reports said reporting periods for the data varied depending on the source.

"Hospitals still are not being transparent and not sharing information with the public especially about infections," Santa said.

In the report, MetroHealth's worst rating was in readmission rates and it received an average rating in infection control and the highest rating possible in best use of CT scanning. The Clinic had a better than average rating in containing infections, below average in communications and the worst possible rating in re-admissions. UH had average ratings in the areas of infection control and CT scanning and below average in re-admission rates and communications.

Both the Clinic and MetroHealth released written statements saying that safety is a top priority, but would not provide a spokesperson to discuss safety issues.

Dr. William Annable, chief officer of UH's Quality Institute, told the Plain Dealer that the ratings not withstanding, action taken by hospitals to improve safety is paramount to patients.

UH's institute established in 2010 has developed databases and standards for patient care in areas including satisfaction, safety, research and education, he said.

"I know we're doing better than a year ago," he said. "But we can't stop there. We all have to work together and aim for 100 percent ratings."

Annable said hospitals need to be transparent to gain patients' confidence and continue to improve care.

UH has been instituting new procedures and letting the staff know that safety is a priority, he said. For example, the senior leadership including the president and chief quality officer, routinely take walking routes on different floors to see how procedures are handled on any given day. It sends a message to doctors, nurses, technicians and other staff members that safety is a top concern, he said.

Electronic medical records are being used to reduce medication and other errors, he said.The Clinic and MetroHealth also use electronic records.

Annable said rates of infections have fallen since UH personnel began using formalized check lists called bundles when performing procedures such as starting central lines.

Annable said improvements are being made more quickly than the data -- typically a year or two old -- reflects. But that's no excuse, he added. "We're all in the same boat and we all need to improve."

Santa said the safety ratings are not meant to be comprehensive when comparing hospitals and should be used in conjunction with other reports including the government's Hospital Compare (hospitalcompare.hhs.gov) and the independent group Leapfrog (leapfroggroup.org). These reports reflect hospitals' specialties such as heart surgery or cancer care.

Both UH and MetroHealth pointed out that they received high ratings from Leapfrog.

There are instances that should never happen in a hospital such as blood clots after surgery, postoperative sepsis or accidental punctures, Santa said. "No matter what's wrong, when a person gets a bedsore in the hospital, that's a terrible thing. When a person falls out of bed and breaks a hip, that's a terrible thing."

Patients need advocates in the hospital, he said. Family members should keep track of what's going on and ask caregivers lots of questions.

"They need to be constructively assertive," he said. "Surveys show that doctors believe it's important that patients know what is going on and what they need to do to get better."

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